P4004 - An Unveiled Case: Disseminated Intravascular Coagulation in the Setting of Acute-on-Chronic Liver Failure

Kikelomo Olaosebikan, MD¹, Ahmed Shehadah, MD², Raissa Nana Sede Mbakop, MD¹, Patrick Berchie, MD^3
1Piedmont Athens Regional Medical Center, Athens, GA; ²Rochester General Hospital, Rochester, NY; ³Piedmont Athens Regional, Athens, GA

Introduction: Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute deterioration of pre-existing chronic liver disease and associated with substantial short-term mortality. Disseminated intravascular coagulation (DIC) is a severe condition characterized by abnormal activation of blood clotting mechanisms throughout the body. We highlight an intriguing and challenging clinical scenario involving a patient with ACLF who presented with the unexpected complication of DIC.

Case Description/Methods: A 47-year-old female with a history of alcohol-related liver cirrhosis and polysubstance use disorder was admitted to the hospital due to acute blood loss anemia caused by acute/dysfunctional uterine bleeding. Despite initial management, her clinical course was marked by unstable hemodynamics, worsening abdominal pain, and multi-organ dysfunction syndrome from undifferentiated shock, necessitating the involvement of a multidisciplinary team. The evaluation revealed DIC as a complicating factor in her underlying liver failure. Despite efforts to manage the coagulopathy and stabilize the patient's condition, the prognosis remained poor, leading to the recommendation of palliative care with hospice due to the patient's unsuitability for emergent liver transplantation.

Discussion: This case serves as a reminder that patients with acute-on-chronic liver failure may develop unexpected complications such as disseminated intravascular coagulation, which can significantly impact their clinical course and prognosis. The interplay between liver dysfunction and coagulation abnormalities can significantly impact patient outcomes. Prompt recognition and management of DIC in ACLF are crucial, but the prognosis remains poor in severe cases. The involvement of a multidisciplinary team is vital in managing these complex patients. Further research is needed to explore potential interventions and improve outcomes in patients with ACLF and DIC.


Disclosures:


Kikelomo Olaosebikan, MD¹, Ahmed Shehadah, MD², Raissa Nana Sede Mbakop, MD¹, Patrick Berchie, MD³. P4004 - An Unveiled Case: Disseminated Intravascular Coagulation in the Setting of Acute-on-Chronic Liver Failure, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.